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State Farm Mutual Automobile Insurance Company 77453-4-A MATCH 01303 MUTL VOL <br /> PO Box2368 DECLARATIONS PAGE <br /> Bloomington IL 6f7O2-2368 <br /> PAGE 1 OF 2 <br /> NAMED INSURED 01303 <br /> 75-8127-4 A A POLICY NUMBER 332 1267-Ed5-75Y <br /> 0fI- — POLICY PERIOD MAY 05 2026 to NOV 05 2026 — <br /> SIMMSGEIGER, MARIA & PATRICK 12:01 A.M.Standard Time <br /> AND DIVERSIFIED WATERSCAPES, <br /> INC 27324 CAMN CAPISTRANO STE 213 STATE FARM PAYMENT PLAN NUMBER <br /> LAGUNA BEACH CA 92677-1118 1346356523 <br /> AGENT <br /> GARYBLACKBURN <br /> 23881 VIA FABRICANTF STE 506 <br /> MISSION VIEJO,CA 92691-3139 <br /> PHONE:(949)581-0800 <br /> DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br /> IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED. <br /> YOUR CAR <br /> Milli R MAKE MODEL BODY STYLE 'VEHICLE ID.NUMBER CLASS <br /> 2006 TOYOTA, TUNDRA PICKUP 5TBJU321765475191 103HCV10 <br /> SYMBOLS COICERAGE&LIMITS PREMIUMS <br /> A Liability Coverage $668.6 <br /> Bodily Injury Limits <br /> Each Person, Each .- <br /> $1,000,000 $1,000,000 <br /> Property Damage Limit.'' <br /> Each Accident <br /> $1,000.000 :. <br /> C Medical Payments Coverage $22.63 <br /> Limit-Each Person <br /> $5,000 _ <br /> D Comprehensive Coverage-$250 Dedu` ,.:: $25.70 <br /> G CoillSi6n Coverage-$500 Deductible $131 98 <br /> H Emergency Road Service Coverage $4 51 <br /> H1 Car Rental and Travel Expenses Covera is $30.99 <br /> Limit-Car Rental Expense::<` <br /> Each Day, Each Lass <br /> $50 $1,500 <br /> U Uninsured Motor Vehicle Coverage $84.74 <br /> Bodily Injury Limits <br /> Each Person, Each Accident <br /> $100,d00 $300;000 <br /> U1 Uninsured Motor Vehicle Property'Damage Coverage 34.82 <br /> T,rtalprgmiluni fbr AY002026J& QV 062 79.98 s not a bill: <br /> IMPORTANT MESSAGES <br /> IMPORTANT NOTICE <br /> For your protection California law requires the following to appear with this policy: Any person who knowingly presents <br /> false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is <br /> guilty of a crime and may be subject to fines and confinement in state prison. <br /> Replaced policy number 3321267-75X. <br /> Notice of insurance information collection practices-personal,family,or household insurance transactions: <br /> We may collect customer information from persons other than the individual or individuals applying for coverage. Such customer <br /> information as well as other personal or privileged information subsequently collected may,in certain circumstances,be disclosed <br /> to third parties without your authorization as permitted by law. <br /> You have the right to submit a written request to access,correct,amend,or delete your personal information and the right to <br /> receive a response within 30 days of submitting your request. If we deny your request,you have the right to fide a statement <br /> with us containing the information you feel is accurate and fair along with the reasons you disagree with our denial.Instructions <br /> on how to file such request and our full privacy notice can be found www.statefarrn.com/customer-care/privacy-security/privacy <br /> or contact your State Farm Agent. <br /> Location used to determine rate charged-29641 VIA CFBOLLA.LAGUNA NIGUEL CA 92677-1924. <br /> CONTINUED <br /> 08719/05773 See Reverse Side <br /> 1553866 CA.2 05-2002 (01n02U.) <br /> nSxON (.1a025te) <br />